✅ Medically reviewed by Dr. Thomas Biernacki, DPM — Board-Certified Podiatrist · Last updated April 6, 2026

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What Is Morton’s Neuroma?

Morton’s neuroma is a thickening of tissue around the nerve between the third and fourth toes, causing sharp, burning pain in the ball of the foot. It often feels like standing on a pebble. Treatment ranges from orthotic inserts and corticosteroid injections to minimally invasive surgery when conservative methods fail.

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Morton’s Neuroma: Symptoms, Causes & Treatment Options

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If you’ve ever felt a burning, electric, or “rock-in-the-shoe” sensation in the ball of your foot that radiates into your third and fourth toes — Morton’s neuroma is one of the most likely culprits. Despite the name, this condition is not a true tumor but a painful thickening of the tissue surrounding the common digital nerve as it passes between the metatarsal bones. Early, targeted treatment resolves the majority of cases without surgery.

What Is Morton’s Neuroma?

Morton’s neuroma — also called interdigital neuroma or Morton’s metatarsalgia — is a benign enlargement (perineural fibrosis) of the common digital nerve, most frequently between the heads of the third and fourth metatarsals. Less commonly it occurs in the second interspace (between the 2nd and 3rd metatarsals). The condition develops when the nerve is repeatedly compressed between the metatarsal heads, leading to inflammation, scar tissue formation, and eventually a palpable or identifiable thickening on ultrasound.

Symptoms of Morton’s Neuroma

Morton’s neuroma produces a distinctive symptom profile that distinguishes it from other causes of ball-of-foot pain:

• Burning or electric pain in the ball of the foot, typically between the 3rd and 4th toes (occasionally 2nd/3rd)
• Radiating pain into adjacent toes — the affected toes may feel numb, tingly, or like they are being squeezed
• “Bunched sock” sensation — a persistent feeling that there is something wadded up under the ball of the foot
• Sharp pain with weight-bearing — especially during push-off or when walking barefoot on hard floors
• Temporary relief when removing shoes and massaging the foot — a hallmark feature
• Worsening in narrow shoes or high heels — lateral compression aggravates the nerve
• Mulder’s click — a palpable or audible click when the foot is squeezed from the sides; present in about 60–70% of cases

What Causes Morton’s Neuroma?

Morton’s neuroma results from chronic compression and irritation of the common digital nerve. Specific contributing factors:

Footwear

Narrow toe boxes and high heels are the most modifiable risk factors. Narrow shoes compress the metatarsal heads together, pinching the interdigital nerve with every step. High heels increase forefoot load by 50–57% and shift the metatarsal heads plantarward, directly compressing the nerve against the deep transverse metatarsal ligament.

Foot Structure

Certain anatomical configurations increase nerve vulnerability:

• Flat feet (hyperpronation) increase instability and nerve shear during each step
• High arches concentrate forefoot load on the metatarsal heads
• Bunions shift the first metatarsal medially, transferring excess load to the second and third interspace
• Hammer toes push the metatarsal head plantarward, increasing compressive force on the nerve

Activity Level

High-impact sports that increase forefoot loading — running, tennis, basketball, hiking — can trigger or exacerbate Morton’s neuroma. Ballet dancers who spend prolonged time en pointe are at particularly high risk due to extreme metatarsal compression.

Intermetatarsal Bursitis

An inflamed bursa between the metatarsal heads can irritate the adjacent nerve and produce neuroma-like symptoms. On ultrasound and MRI, an intermetatarsal bursa and a true neuroma often coexist and are treated similarly.

Diagnosis

Morton’s neuroma is primarily a clinical diagnosis — a thorough history and physical exam are usually sufficient for an experienced podiatrist. Diagnostic confirmation comes from:

• Mulder’s test — transverse compression of the metatarsal heads while pressing on the interspace from below; a click, pain, or numbness is positive
• Ultrasound imaging — highly sensitive (90%+) for neuromas ≥5mm; allows real-time dynamic assessment and can guide injections; no radiation
• MRI — most sensitive for small neuromas; differentiates neuroma from bursa, plantar plate pathology, and stress fracture
• X-ray — used to rule out bony pathology; doesn’t visualize soft tissue neuromas

Non-Surgical Treatment

The majority of Morton’s neuroma patients (70–80%) achieve adequate relief with conservative measures:

Footwear Change

Switching to shoes with a wide toe box, adequate forefoot cushioning, and a low heel (under 1 inch) is the cornerstone of conservative treatment. This single change often produces significant improvement within 1–2 weeks. Look for shoes where you can wiggle all toes freely and where the widest part of the shoe matches the widest part of your foot.

Metatarsal Pad Placement

A correctly positioned metatarsal pad — placed just behind (proximal to) the 3rd-4th metatarsal heads — spreads the metatarsals apart, relieving pressure on the nerve. Placement is critical: a pad at the metatarsal heads increases, not decreases, compressive force. A podiatrist can verify correct positioning.

Corticosteroid Injections

An ultrasound-guided cortisone injection directly into the neuroma or surrounding bursa reduces inflammation and neural edema. Studies show 60–80% of patients experience significant relief after a series of 1–3 injections. Effects typically last several months; some patients achieve long-term remission. Injections are most effective when combined with footwear changes and metatarsal pads — not used in isolation.

MLS Laser Therapy

MLS laser therapy uses dual-wavelength photobiomodulation to reduce perineural inflammation and promote nerve healing. It’s an excellent option for patients who want to avoid cortisone or have had limited injection response. A typical course is 6–8 sessions, and many patients report meaningful improvement in burning and tingling.

Custom Orthotics

For patients with underlying biomechanical contributors (pronation, bunions, uneven metatarsal loading), custom orthotics address the root cause of nerve compression. They incorporate a metatarsal dome positioned to spread the metatarsal heads and can be combined with a first metatarsal cutout to restore normal load distribution.

Sclerosing Alcohol Injections

A series of ultrasound-guided injections of dilute alcohol (4–20% ethanol solution) can chemically ablate neuroma tissue, reducing its size and symptomatology without surgery. Multiple injections (typically 4–7 sessions) are required. Studies show 60–89% success rates in appropriately selected patients. This is a good option for patients who have failed cortisone and want to avoid excision.

Surgical Treatment: Neurectomy

When conservative care fails after 6 months of dedicated treatment, surgical excision of the neuroma (neurectomy) is highly effective, with success rates of 75–95%. The procedure is performed as an outpatient under local anesthesia with sedation. Dr. Biernacki uses a dorsal (top-of-foot) approach that allows faster recovery and excellent visualization.

After neurectomy, patients should expect permanent numbness between the affected toes — this is expected and the vast majority of patients find it preferable to the pre-surgical pain. Patients walk in a surgical shoe immediately and return to regular shoes within 3–4 weeks.

Frequently Asked Questions

If you’re experiencing burning, electric pain in the ball of the foot in Southeast Michigan, Dr. Tom Biernacki DPM at Balance Foot & Ankle — with offices in Howell and Bloomfield Hills — provides on-site ultrasound, ultrasound-guided injections, and comprehensive Morton’s neuroma treatment. schedule a podiatry appointment

Medical References & Sources

• American Orthopaedic Foot & Ankle Society — Morton’s Neuroma
• PubMed Research — Morton’s Neuroma Treatment

In-Office Treatment at Balance Foot & Ankle

When home treatment fails to resolve Morton’s neuroma symptoms, our clinic offers diagnostic ultrasound to confirm neuroma size and location, corticosteroid injections for acute pain relief, alcohol sclerosing injections to shrink the neuroma over a series of treatments, custom orthotics with metatarsal pads to decompress the intermetatarsal space, MLS laser therapy for inflammation reduction, and surgical neurectomy for refractory cases. Dr. Tom uses a conservative-first approach, with over 80% of patients avoiding surgery.

Same-day appointments available. (810) 206-1402 · Book now →

Dr. Tom’s Recommended Products for Morton’s Neuroma

PowerStep Pinnacle Orthotic Insoles — The OTC orthotic I recommend most in our clinic. Medical-grade arch support with built-in metatarsal support helps spread the metatarsal heads and decompress the nerve. Not ideal for: narrow dress shoes without removable insoles.

Doctor Hoy’s Natural Pain Relief Gel — Natural topical pain relief I use in our clinic. Arnica + camphor formula — massage into the ball of foot between the affected toes 3-4x daily. Not ideal for: open wounds or broken skin.

Foot Petals Tip Toes — Designed specifically for women’s shoes where a full insole won’t fit. Discreet ball-of-foot cushioning that helps with neuroma pressure in heels. Not ideal for: athletic shoes (use PowerStep instead).

Affiliate disclosure: We may earn a commission on products purchased through our links, at no extra cost to you. All recommendations are based on clinical experience.

→ Browse all recommended products · Foundation Wellness portfolio

Related Guides

• Metatarsalgia: Ball of Foot Pain Guide
• Podiatrist-Recommended Shoes 2026 — wide toe box options
• Best Orthotics for Foot Pain
• Custom Orthotics Guide
• Neuropathy Symptoms Guide

Serving Howell, MI 48843 and Bloomfield Hills, MI 48302. Schedule your appointment today · (810) 206-1402

Get Relief from Morton’s Neuroma Pain

That burning, tingling sensation between your toes doesn’t have to control your life. Our podiatrists offer non-surgical treatment options that can eliminate Morton’s neuroma pain.

Clinical References

1. Jain S, Mannan K. The diagnosis and management of Morton’s neuroma: a literature review. Foot Ankle Spec. 2013;6(4):307-317.
2. Thomson CE, Gibson JNA, Martin D. Interventions for the treatment of Morton’s neuroma. Cochrane Database Syst Rev. 2004;(3):CD003118.
3. Betts LO. Morton’s metatarsalgia: neuritis of the fourth digital nerve. Med J Aust. 1940;1:514-515.